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Garcia-Agundez A, Ojo O, Hernández-Roig HA, Baquero C, Frey D, Georgiou C, Goessens M, Lillo RE, Menezes R, Nicolaou N, Ortega A, Stavrakis E, Fernandez Anta A. Estimating the COVID-19 Prevalence in Spain With Indirect Reporting via Open Surveys. Front Public Health 2021; 9:658544. [PMID: 33898383 PMCID: PMC8062708 DOI: 10.3389/fpubh.2021.658544] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/10/2021] [Indexed: 12/13/2022] Open
Abstract
During the initial phases of the COVID-19 pandemic, accurate tracking has proven unfeasible. Initial estimation methods pointed toward case numbers that were much higher than officially reported. In the CoronaSurveys project, we have been addressing this issue using open online surveys with indirect reporting. We compare our estimates with the results of a serology study for Spain, obtaining high correlations (R squared 0.89). In our view, these results strongly support the idea of using open surveys with indirect reporting as a method to broadly sense the progress of a pandemic.
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Affiliation(s)
- Augusto Garcia-Agundez
- Multimedia Communications Lab, etit, Technische Universität Darmstadt, Darmstadt, Germany
| | | | | | - Carlos Baquero
- Departamento de Informática, University of Minho, Braga, Portugal
| | - Davide Frey
- University of Rennes, Institut National de Recherche en Informatique et en Automatique, Centre National de la Recherche Scientifique, Institut de Recherche en Informatique et Systèmes Aléatoires, Rennes, France
| | - Chryssis Georgiou
- Department of Computer Science, University of Cyprus, Nicosia, Cyprus
| | | | - Rosa E Lillo
- University Carlos III de Madrid - Santander Big Data Institute, Madrid, Spain
| | - Raquel Menezes
- Departamento de Matemática, University of Minho, Braga, Portugal
| | | | - Antonio Ortega
- Department of Electrical and Computer Engineering, USC Viterbi School of Engineering, Los Angeles, CA, United States
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52
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Sweeney N, Merrick B, Pedro Galão R, Pickering S, Botgros A, Wilson HD, Signell AW, Betancor G, Tan MKI, Ramble J, Kouphou N, Acors S, Graham C, Seow J, MacMahon E, Neil SJD, Malim MH, Doores K, Douthwaite S, Batra R, Nebbia G, Edgeworth JD. Clinical utility of targeted SARS-CoV-2 serology testing to aid the diagnosis and management of suspected missed, late or post-COVID-19 infection syndromes: Results from a pilot service implemented during the first pandemic wave. PLoS One 2021; 16:e0249791. [PMID: 33826651 PMCID: PMC8026061 DOI: 10.1371/journal.pone.0249791] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 03/24/2021] [Indexed: 01/15/2023] Open
Abstract
During the first wave of the global COVID-19 pandemic the clinical utility and indications for SARS-CoV-2 serological testing were not clearly defined. The urgency to deploy serological assays required rapid evaluation of their performance characteristics. We undertook an internal validation of a CE marked lateral flow immunoassay (LFIA) (SureScreen Diagnostics) using serum from SARS-CoV-2 RNA positive individuals and pre-pandemic samples. This was followed by the delivery of a same-day named patient SARS-CoV-2 serology service using LFIA on vetted referrals at central London teaching hospital with clinical interpretation of result provided to the direct care team. Assay performance, source and nature of referrals, feasibility and clinical utility of the service, particularly benefit in clinical decision-making, were recorded. Sensitivity and specificity of LFIA were 96.1% and 99.3% respectively. 113 tests were performed on 108 participants during three-week pilot. 44% participants (n = 48) had detectable antibodies. Three main indications were identified for serological testing; new acute presentations potentially triggered by recent COVID-19 e.g. pulmonary embolism (n = 5), potential missed diagnoses in context of a recent COVID-19 compatible illness (n = 40), and making infection control or immunosuppression management decisions in persistently SARS-CoV-2 RNA PCR positive individuals (n = 6). We demonstrate acceptable performance characteristics, feasibility and clinical utility of using a LFIA that detects anti-spike antibodies to deliver SARS-CoV-2 serology service in adults and children. Greatest benefit was seen where there is reasonable pre-test probability and results can be linked with clinical advice or intervention. Experience from this pilot can help inform practicalities and benefits of rapidly implementing new tests such as LFIAs into clinical service as the pandemic evolves.
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Affiliation(s)
- Nicola Sweeney
- Department of Infectious Diseases, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Blair Merrick
- Department of Infectious Diseases, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Department of Infectious Diseases, Centre for Clinical Infection and Diagnostics Research, School of Immunology and Microbial Sciences, King’s College London, London, United Kingdom
| | - Rui Pedro Galão
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King’s College London, London, United Kingdom
| | - Suzanne Pickering
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King’s College London, London, United Kingdom
| | - Alina Botgros
- Department of Infectious Diseases, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Harry D. Wilson
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King’s College London, London, United Kingdom
| | - Adrian W. Signell
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King’s College London, London, United Kingdom
| | - Gilberto Betancor
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King’s College London, London, United Kingdom
| | - Mark Kia Ik Tan
- Department of Infectious Diseases, Centre for Clinical Infection and Diagnostics Research, School of Immunology and Microbial Sciences, King’s College London, London, United Kingdom
| | - John Ramble
- Infection Sciences, Viapath LLP, St Thomas’ Hospital, London, United Kingdom
| | - Neophytos Kouphou
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King’s College London, London, United Kingdom
| | - Sam Acors
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King’s College London, London, United Kingdom
| | - Carl Graham
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King’s College London, London, United Kingdom
| | - Jeffrey Seow
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King’s College London, London, United Kingdom
| | - Eithne MacMahon
- Department of Infectious Diseases, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Department of Infectious Diseases, Centre for Clinical Infection and Diagnostics Research, School of Immunology and Microbial Sciences, King’s College London, London, United Kingdom
| | - Stuart J. D. Neil
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King’s College London, London, United Kingdom
| | - Michael H. Malim
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King’s College London, London, United Kingdom
| | - Katie Doores
- Department of Infectious Diseases, School of Immunology & Microbial Sciences, King’s College London, London, United Kingdom
| | - Sam Douthwaite
- Department of Infectious Diseases, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Department of Infectious Diseases, Centre for Clinical Infection and Diagnostics Research, School of Immunology and Microbial Sciences, King’s College London, London, United Kingdom
| | - Rahul Batra
- Department of Infectious Diseases, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Department of Infectious Diseases, Centre for Clinical Infection and Diagnostics Research, School of Immunology and Microbial Sciences, King’s College London, London, United Kingdom
| | - Gaia Nebbia
- Department of Infectious Diseases, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Department of Infectious Diseases, Centre for Clinical Infection and Diagnostics Research, School of Immunology and Microbial Sciences, King’s College London, London, United Kingdom
| | - Jonathan D. Edgeworth
- Department of Infectious Diseases, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Department of Infectious Diseases, Centre for Clinical Infection and Diagnostics Research, School of Immunology and Microbial Sciences, King’s College London, London, United Kingdom
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53
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Airoldi C, Patrucco F, Milano F, Alessi D, Sarro A, Rossi MA, Cena T, Borrè S, Faggiano F. High Seroprevalence of SARS-CoV-2 among Healthcare Workers in a North Italy Hospital. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073343. [PMID: 33804893 PMCID: PMC8037577 DOI: 10.3390/ijerph18073343] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 12/14/2022]
Abstract
Background: Healthcare workers (HCWs) have been the key players in the fight against the coronavirus disease 2019 (COVID-19) pandemic. The aim of our study was to evaluate the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) IgG anti-bodies. Methods: We conducted a cross-sectional study among workers of two hospitals and Territorial Medical and Administrative services in Northern Italy. From 8 May to 3 June 2020, 2252 subjects were tested. Seroprevalence and 95% confidence interval (CI) were calculated for all individuals who were stratified by job title, COVID-19 risk of exposure, direct contact with patients, unit ward, and intensity of care. Results: Median age was 50 years, and 72% of subjects were female. The overall seroprevalence was 17.11% [95% CI 15.55–18.67]. Around 20% of healthcare assistants were seropositive, followed by physicians and nurses (16.89% and 15.84%, respectively). HCWs with high risk of exposure to COVID-19 were more frequently seropositive (28.52%) with respect to those with medium and low risks (16.71% and 12.76%, respectively). Moreover, personnel in direct contact had higher prevalence (18.32%) compared to those who did not (10.66%). Furthermore, the IgG were more frequently detected among personnel of one hospital (19.43%). Conclusion: The high seroprevalence observed can be partially explained by the timing and the population seroprevalence; the study was conducted in an area with huge spread of the infection.
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Affiliation(s)
- Chiara Airoldi
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, 28100 Novara, Italy; (A.S.); (F.F.)
- Correspondence: ; Tel.: +39-0321-373-2183
| | - Filippo Patrucco
- Osservatorio Epidemiologico, 13100 Vercelli, Italy; (F.P.); (F.M.); (D.A.); (M.A.R.); (T.C.); (S.B.)
| | - Fulvia Milano
- Osservatorio Epidemiologico, 13100 Vercelli, Italy; (F.P.); (F.M.); (D.A.); (M.A.R.); (T.C.); (S.B.)
| | - Daniela Alessi
- Osservatorio Epidemiologico, 13100 Vercelli, Italy; (F.P.); (F.M.); (D.A.); (M.A.R.); (T.C.); (S.B.)
| | - Andrea Sarro
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, 28100 Novara, Italy; (A.S.); (F.F.)
| | - Maicol Andrea Rossi
- Osservatorio Epidemiologico, 13100 Vercelli, Italy; (F.P.); (F.M.); (D.A.); (M.A.R.); (T.C.); (S.B.)
| | - Tiziana Cena
- Osservatorio Epidemiologico, 13100 Vercelli, Italy; (F.P.); (F.M.); (D.A.); (M.A.R.); (T.C.); (S.B.)
| | - Silvio Borrè
- Osservatorio Epidemiologico, 13100 Vercelli, Italy; (F.P.); (F.M.); (D.A.); (M.A.R.); (T.C.); (S.B.)
| | - Fabrizio Faggiano
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, 28100 Novara, Italy; (A.S.); (F.F.)
- Osservatorio Epidemiologico, 13100 Vercelli, Italy; (F.P.); (F.M.); (D.A.); (M.A.R.); (T.C.); (S.B.)
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54
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Woon YL, Lee YL, Chong YM, Ayub NA, Krishnabahawan SL, Lau JFW, Subramaniam-Kalianan R, Sam IC, Chan YF, Sevalingam RK, Ramli A, Chuah CH, Mat-Hussin H, Leong CL, Chidambaram SK, Peariasamy KM, Goh PP. Serology surveillance of SARS-CoV-2 antibodies among healthcare workers in COVID-19 designated facilities in Malaysia. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2021; 9:100123. [PMID: 33778796 PMCID: PMC7982055 DOI: 10.1016/j.lanwpc.2021.100123] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/13/2021] [Accepted: 02/22/2021] [Indexed: 01/10/2023]
Abstract
Background Asymptomatic severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infections are well documented. Healthcare workers (HCW) are at increased risk of infection due to occupational exposure to infected patients. We aim to determine the prevalence of SARS-CoV-2 antibodies among HCW who did not come to medical attention. Methods We prospectively recruited 400 HCW from the National Public Health Laboratory and two COVID-19 designated public hospitals in Klang Valley, Malaysia between 13/4/2020 and 12/5/2020. Quota sampling was used to ensure representativeness of HCW involved in direct and indirect patient care. All participants answered a self-administered questionnaire and blood samples were taken to test for SARS-CoV-2 antibodies by surrogate virus neutralization test. Findings The study population comprised 154 (38.5%) nurses, 103 (25.8%) medical doctors, 47 (11.8%) laboratory technologists and others (23.9%). A majority (68.9%) reported exposure to SARS-CoV-2 in the past month within their respective workplaces. Adherence to personal protection equipment (PPE) guidelines and hand hygiene were good, ranging from 91-100% compliance. None (95% CI: 0, 0.0095) of the participants had SARS-CoV-2 antibodies detected, despite 182 (45.5%) reporting some symptoms one month prior to study recruitment. One hundred and fifteen (29%) of participants claimed to have had contact with known COVID-19 persons outside of their workplace. Interpretation Zero seroprevalence among HCW suggests a low incidence of undiagnosed COVID-19 infection in our healthcare setting during the first local wave of SARS-CoV-2 infection. The occupational risk of SARS-CoV-2 transmission within healthcare facilities can be prevented by adherence to infection control measures and appropriate use of PPE. Funding Own institutional budget and the Fundamental Research Grant Scheme.
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Affiliation(s)
- Yuan Liang Woon
- Center for Clinical Epidemiology, Institute for Clinical Research, National Institutes of Health, Ministry of Health, Malaysia
| | - Yee Leng Lee
- Clinical Research Center, Sungai Buloh Hospital, Ministry of Health, Malaysia.,Institute for Clinical Research, National Institutes of Health, Ministry of Health, Malaysia
| | - Yoong Min Chong
- Department of Medical Microbiology, Faculty of Medicine, University Malaya, Malaysia
| | - Nor Aliya Ayub
- Clinical Research Center, Kuala Lumpur Hospital, Ministry of Health, Malaysia
| | | | - June Fei Wen Lau
- Center for Clinical Epidemiology, Institute for Clinical Research, National Institutes of Health, Ministry of Health, Malaysia
| | - Ramani Subramaniam-Kalianan
- Center for Clinical Epidemiology, Institute for Clinical Research, National Institutes of Health, Ministry of Health, Malaysia
| | - I-Ching Sam
- Department of Medical Microbiology, Faculty of Medicine, University Malaya, Malaysia
| | - Yoke Fun Chan
- Department of Medical Microbiology, Faculty of Medicine, University Malaya, Malaysia
| | | | - Azura Ramli
- Clinical Research Center, Kuala Lumpur Hospital, Ministry of Health, Malaysia
| | - Chuan Huan Chuah
- Infectious Disease Unit, Medical Department, Sungai Buloh Hospital, Ministry of Health, Malaysia
| | - Hani Mat-Hussin
- National Public Health Laboratory, Ministry of Health, Malaysia
| | - Chee Loon Leong
- Infectious Disease Unit, Medical Department, Kuala Lumpur Hospital, Ministry of Health, Malaysia
| | - Suresh Kumar Chidambaram
- Infectious Disease Unit, Medical Department, Sungai Buloh Hospital, Ministry of Health, Malaysia
| | - Kalaiarasu M Peariasamy
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Malaysia
| | - Pik Pin Goh
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Malaysia
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55
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Pallett SJC, Denny SJ, Patel A, Charani E, Mughal N, Stebbing J, Davies GW, Moore LSP. Point-of-care SARS-CoV-2 serological assays for enhanced case finding in a UK inpatient population. Sci Rep 2021; 11:5860. [PMID: 33712679 PMCID: PMC7955061 DOI: 10.1038/s41598-021-85247-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 02/23/2021] [Indexed: 12/13/2022] Open
Abstract
Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) has become a global pandemic. Case identification is currently made by real-time polymerase chain reaction (PCR) during the acute phase and largely restricted to healthcare laboratories. Serological assays are emerging but independent validation is urgently required to assess their utility. We evaluated five different point-of-care (POC) SARS-CoV-2 antibody test kits against PCR, finding concordance across the assays (n = 15). We subsequently tested 200 patients using the OrientGene COVID-19 IgG/IgM Rapid Test Cassette and find a sensitivity of 74% in the early infection period (day 5–9 post symptom onset), with 100% sensitivity not seen until day 13, demonstrating inferiority to PCR testing in the infectious period. Negative rate was 96%, but in validating the serological tests uncovered potential false-negatives from PCR testing late-presenting cases. A positive predictive value (PPV) of 37% in the general population precludes any use for general screening. Where a case definition is applied however, the PPV is substantially improved (95.4%), supporting use of serology testing in carefully targeted, high-risk populations. Larger studies in specific patient cohorts, including those with mild infection are urgently required to inform on the applicability of POC serological assays to help control the spread of SARS-CoV-2 and improve case finding of patients that may experience late complications.
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Affiliation(s)
- S J C Pallett
- Centre of Defence Pathology, Royal Centre for Defence Medicine, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK.,Clinical Infection Department, Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK
| | - S J Denny
- Clinical Infection Department, Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK.,North West London Pathology, Fulham Palace Road, London, W6 8RF, UK
| | - A Patel
- Clinical Infection Department, Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK
| | - E Charani
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK
| | - N Mughal
- Clinical Infection Department, Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK.,North West London Pathology, Fulham Palace Road, London, W6 8RF, UK.,NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK
| | - J Stebbing
- Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK
| | - G W Davies
- Clinical Infection Department, Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK
| | - L S P Moore
- Clinical Infection Department, Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK. .,North West London Pathology, Fulham Palace Road, London, W6 8RF, UK. .,NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK.
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56
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Hossain A, Nasrullah SM, Tasnim Z, Hasan M, Hasan M. Seroprevalence of SARS-CoV-2 IgG antibodies among health care workers prior to vaccine administration in Europe, the USA and East Asia: A systematic review and meta-analysis. EClinicalMedicine 2021; 33:100770. [PMID: 33718853 PMCID: PMC7938754 DOI: 10.1016/j.eclinm.2021.100770] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/06/2021] [Accepted: 02/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Knowing the seroprevalence of SARS-CoV-2 IgG antibodies across geographic regions before vaccine administration is one key piece of knowledge to achieve herd immunity. While people of all ages, occupations, and communities are at risk of getting infected with SARS-CoV-2, the health care workers (HCWs) are possibly at the highest risk. Most seroprevalence surveys with HCWs conducted worldwide have been limited to Europe, North America, and East Asia. We aimed to understand how the seroprevalence of SARS-CoV-2 IgG antibodies varied across these geographic regions among HCWs based on the available evidences. METHODS By searching through PubMed, ScienceDirect, and Google Scholar databases, eligible studies published from January 1, 2020 to January 15, 2021 were included for the systematic review and meta-analysis. The random-effects model was used to estimate the pooled proportion of IgG seropositive HCWs. Publication bias was assessed by funnel plot and confirmed by Egger's test. Heterogeneity was quantified using I2 statistics. We performed sensitivity analyses based on sample size, diagnostic method and publication status. The study protocol was registered with PROSPERO (CRD42020219086). FINDINGS A total of 53 peer-reviewed articles were selected, including 173,353 HCWs (32.7% male) from the United States, ten European, and three East Asian countries. The overall seropositive prevalence rate of IgG antibodies was 8.6% in these regions (95% CI= 7.2-9.9%). Pooled seroprevalence of IgG antibodies was higher in studies conducted in the USA (12.4%, 95% CI= 7.8-17%) than in Europe (7.7%, 95% CI=6.3-9.2%) and East Asia (4.8%, 95% CI=2.9-6.7%). The subgroup study also estimated that male HCWs had 9.4% (95% CI= 7.2-11.6%) IgG seroconversion, and female HCWs had 7.8% (95% CI=5.9-9.7%). The study exhibits a high prevalence of IgG antibodies among HCWs under 40 years in the USA, conversely, it was high in older HCWs (≥40 years of age) in Europe and East Asia. In the months February-April 2020, the estimated pooled seroprevalence was 5.7% (4.0-7.4%) that increased to 8·2% (6.2-10%) in April-May and further to 9.9% (6.9-12.9%) in the May-September time-period. INTERPRETATION In the view of all evidence to date, a significant variation in the prevalence of SARS-CoV-2 antibodies in HCWs is observed in regions of Europe, the United States, and East Asia. The patterns of IgG antibodies by time, age, and gender suggest noticeable regional differences in transmission of the virus. Based on the insights driven from the analysis, priority is required for effective vaccination for older HCWs from Europe and East Asia. A considerable high seroprevalence of IgG among HCWs from the USA suggests a high rate of past infection that indicates the need to take adequate measures to prevent hospital spread. Moreover, the seroprevalence trend was not substantially changed after May 2020, suggesting a slow progression of long-term SARS-CoV-2 immunity. Routine testing of HCWs for SARS-CoV-2 should be considered even after the rollout of vaccination to identify the areas of increased transmission. FUNDING None.
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Affiliation(s)
- Ahmed Hossain
- Department of Public Health, North South University, Dhaka, Bangladesh
- Global Health Institute, North South University, Dhaka, Bangladesh
- Health Management BD Foundation, Dhaka, Bangladesh
| | | | - Zarrin Tasnim
- Department of Public Health, North South University, Dhaka, Bangladesh
| | - Md.Kamrul Hasan
- Department of Public Health, North South University, Dhaka, Bangladesh
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Saeed U, Uppal SR, Piracha ZZ, Rasheed A, Aftab Z, Zaheer H, Uppal R. Evaluation of SARS-CoV-2 antigen-based rapid diagnostic kits in Pakistan: formulation of COVID-19 national testing strategy. Virol J 2021; 18:34. [PMID: 33581714 PMCID: PMC7881305 DOI: 10.1186/s12985-021-01505-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/02/2021] [Indexed: 12/22/2022] Open
Abstract
Rapid diagnosis of SARS-CoV-2 during pandemic enables timely treatment and prevention of COVID-19. Evaluating the accuracy and reliability of rapid diagnostic testing kits is crucial for surveillance and diagnosis of SARS-CoV-2 infections in general population, injection drug users, multi-transfused populations, healthcare workers, prisoners, barbers and other high risk populations. The aim of this study was to evaluate performance and effectiveness of nasopharyngeal swab (NSP) and saliva based rapid antigen detection testing kits in comparison with USFDA approved triple target gold standard real-time polymerase chain reaction. A cross-sectional study was conducted on 33,000 COVID-19 suspected patients. From RT-PCR positive patients, nasopharyngeal swab (NSP) and saliva samples were obtained for evaluation of rapid COVID-19 testing kits (RDT). 100/33,000 (0.3%) of specimens were RT-PCR positive for SARS-CoV-2. Among RT-PCR positive, 62% were males, 34% were females, and 4% were children. The NSP-RDT (Lepu Medical China) analysis revealed 53% reactivity among males, 58% reactivity among females, and 25% reactivity among children. However saliva based RDT (Lepu Medical China) analysis showed 21% reactivity among males and 23% among females, and no reactivity in children. False negative results were significantly more pronounced in saliva based RDT as compared to NSP-RDT. The sensitivity of these NSP-RDT and saliva based RDT were 52% and 21% respectively. The RDTs evaluated in this study showed limited sensitivities in comparison to gold standard RT-PCR, indicating that there is a dire need in Pakistan for development of suitable testing to improve accurate COVID-19 diagnosis in line with national demands.
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Affiliation(s)
- Umar Saeed
- Department of Research and Development, Islamabad Diagnostic Center (IDC), F8 Markaz, Islamabad, 44000, Pakistan.
| | - Sara Rizwan Uppal
- Department of Research and Development, Islamabad Diagnostic Center (IDC), F8 Markaz, Islamabad, 44000, Pakistan
| | - Zahra Zahid Piracha
- Department of Research and Development, Islamabad Diagnostic Center (IDC), F8 Markaz, Islamabad, 44000, Pakistan
| | - Azhar Rasheed
- Department of Research and Development, Islamabad Diagnostic Center (IDC), F8 Markaz, Islamabad, 44000, Pakistan
| | - Zubair Aftab
- Islamabad Diagnostic Center (IDC), G8 Markaz, Islamabad, 44000, Pakistan
| | - Hafsah Zaheer
- Islamabad Diagnostic Center (IDC), G8 Markaz, Islamabad, 44000, Pakistan
| | - Rizwan Uppal
- Department of Research and Development, Islamabad Diagnostic Center (IDC), F8 Markaz, Islamabad, 44000, Pakistan
- Islamabad Diagnostic Center (IDC), G8 Markaz, Islamabad, 44000, Pakistan
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58
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SARS-CoV-2 Seroprevalence in Healthcare Workers of Kaunas Hospitals during the First Wave of the COVID-19 Pandemic. MEDICINA-LITHUANIA 2021; 57:medicina57020148. [PMID: 33562085 PMCID: PMC7915158 DOI: 10.3390/medicina57020148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/19/2021] [Accepted: 02/02/2021] [Indexed: 11/26/2022]
Abstract
Background and objective: Serologic testing is a useful additional method for the diagnosis of COVID-19. It is also used for population-based seroepidemiological studies. The objective of the study was to determine SARS-CoV-2 seroprevalence in healthcare workers of Kaunas hospitals and to compare two methods for specific SARS-CoV-2 antibody testing. Materials and Methods: A total of 432 healthcare workers in Kaunas hospitals were enrolled in this study. Each participant filled a questionnaire including questions about their demographics, contact with suspected or confirmed COVID-19, acute respiratory symptoms, and whether they contacted their general practitioner, could not come to work, or had to be hospitalized. Capillary blood was used to test for SARS-CoV-2 specific immunoglobulin G (IgG) and immunoglobulin M (IgM) a lateral flow immunoassay. Serum samples were used to test for specific IgG and IgA class immunoglobulins using semiquantitative enzyme-linked immunosorbent assay (ELISA) method. Results: 24.77% of study participants had direct contact with a suspected or confirmed case of COVID-19. A total of 64.81% of studied individuals had at least one symptom representing acute respiratory infection, compatible with COVID-19. Lateral flow immunoassay detected SARS-CoV-2 specific IgG class immunoglobulins in 1.16% of the tested group. Fever, cough, dyspnea, nausea, diarrhea, headache, conjunctivitis, muscle pain, and loss of smell and taste predominated in the anti-SARS-CoV-2 IgG-positive group. Using ELISA, specific IgG were detected in 1.32% of the tested samples. Diarrhea, loss of appetite, and loss of smell and taste sensations were the most predominant symptoms in anti-SARS-CoV-2 IgG-positive group. The positive percent agreement of the two testing methods was 50%, and negative percent agreement was 99.66%. Conclusions: 1.16% of tested healthcare workers of Kaunas hospitals were anti-SARS-CoV-2 IgG-positive. The negative percent agreement of the lateral flow immunoassay and ELISA exceeded 99%.
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Milazzo L, Lai A, Pezzati L, Oreni L, Bergna A, Conti F, Meroni C, Minisci D, Galli M, Corbellino M, Antinori S, Ridolfo AL. Dynamics of the seroprevalence of SARS-CoV-2 antibodies among healthcare workers at a COVID-19 referral hospital in Milan, Italy. Occup Environ Med 2021; 78:oemed-2020-107060. [PMID: 33542096 PMCID: PMC7868130 DOI: 10.1136/oemed-2020-107060] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/18/2020] [Accepted: 12/01/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Healthcare workers (HCWs) are at high risk of developing SARS-CoV-2 infection. The aim of this single-centre prospective study was to evaluate the trend of SARS-CoV-2 seroprevalence in HCWs working at the primary referral centre for infectious diseases and bioemergencies (eg, COVID-19) in Northern Italy and investigate the factors associated with seroconversion. METHODS Six hundred and seventy-nine HCW volunteers were tested for anti-SARS-CoV-2 antibodies three times between 4 March and 27 May 2020 and completed a questionnaire covering COVID-19 exposure, symptoms and personal protective equipment (PPE) training and confidence at each time. RESULTS SARS-CoV-2 seroprevalence rose from 3/679 to 26/608 (adjusted prevalence: 0.5%, 95% CI 0.1 to 1.7% and 5.4%, 95% CI 3.6 to 7.9, respectively) between the first two time points and then stabilised, in line with the curve of the COVID-19 epidemic in Milan. From the first time point, 61.6% of the HCWs had received training in the use of PPE and 17 (61.5%) of those who proved to be seropositive reported symptoms compatible with SARS-CoV-2 infection. Contacts with ill relatives or friends and self-reported symptoms were independently associated with an increased likelihood of seroconversion (p<0.0001 for both), whereas there was no significant association with professional exposure. CONCLUSION The seroprevalence of SARS-CoV-2 among the HCWs at our COVID-19 referral hospital was low at the time of the peak of the epidemic. The seroconversions were mainly attributable to extrahospital contacts, probably because the hospital readily adopted effective infection control measures. The relatively high number of asymptomatic seropositive HCWs highlights the need to promptly identify and isolate potentially infectious HCWs.
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Affiliation(s)
- Laura Milazzo
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Alessia Lai
- Luigi Sacco Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milano, Lombardia, Italy
| | - Laura Pezzati
- Luigi Sacco Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milano, Lombardia, Italy
| | - Letizia Oreni
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Annalisa Bergna
- Luigi Sacco Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milano, Lombardia, Italy
| | - Federico Conti
- Luigi Sacco Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milano, Lombardia, Italy
| | - Cristina Meroni
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Davide Minisci
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Massimo Galli
- Luigi Sacco Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milano, Lombardia, Italy
| | - Mario Corbellino
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Spinello Antinori
- Luigi Sacco Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milano, Lombardia, Italy
| | - Anna Lisa Ridolfo
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy
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Chan CW, Shahul S, Coleman C, Tesic V, Parker K, Yeo KTJ. Evaluation of the Truvian Easy Check COVID-19 IgM/IgG Lateral Flow Device for Rapid Anti-SARS-CoV-2 Antibody Detection. Am J Clin Pathol 2021; 155:286-295. [PMID: 33135049 PMCID: PMC7665287 DOI: 10.1093/ajcp/aqaa221] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To evaluate the analytical and clinical performance of the Truvian Easy Check coronavirus disease 2019 (COVID-19) IgM/IgG anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody test.Serologic assays have become increasingly available for surveillance through the Food and Drug Administration emergency use authorization in the ongoing COVID-19 global pandemic. However, widespread application of serologic assays has been curbed by reports of faulty or inaccurate tests. Therefore, rapid COVID-19 antibody tests need to be thoroughly validated prior to their implementation. METHODS The Easy Check device was analytically evaluated and its performance was compared with the Roche Elecsys anti-SARS-CoV-2 antibody assay. The test was further characterized for cross-reactivity using sera obtained from patients infected by other viruses. Clinical performance was analyzed with polymerase chain reaction-confirmed samples and a 2015 prepandemic reference sample set. RESULTS The Easy Check device showed excellent analytical performance and compares well with the Roche Elecsys antibody assay, with an overall concordance of 98.6%. Clinical performance showed a sensitivity of 96.6%, a specificity of 98.2%, and an overall accuracy of 98.1%. CONCLUSIONS The Easy Check device is a simple, reliable, and rapid test for detection of SARS-CoV-2 seropositivity, and its performance compares favorably against the automated Roche Elecsys antibody assay.
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Affiliation(s)
| | - Sajid Shahul
- Department of Anesthesia and Critical Care, Chicago, IL
- Pritzker School of Medicine, University of Chicago, Chicago, IL
| | - Cheyenne Coleman
- Clinical Chemistry Laboratory, University of Chicago Hospitals, Chicago, IL
| | - Vera Tesic
- Department of Pathology, Chicago, IL
- Pritzker School of Medicine, University of Chicago, Chicago, IL
| | | | - Kiang-Teck J Yeo
- Department of Pathology, Chicago, IL
- Pritzker School of Medicine, University of Chicago, Chicago, IL
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Lei Q, Li Y, Hou H, Wang F, Ouyang Z, Zhang Y, Lai D, Banga Ndzouboukou J, Xu Z, Zhang B, Chen H, Xue J, Lin X, Zheng Y, Yao Z, Wang X, Yu C, Jiang H, Zhang H, Qi H, Guo S, Huang S, Sun Z, Tao S, Fan X. Antibody dynamics to SARS-CoV-2 in asymptomatic COVID-19 infections. Allergy 2021; 76:551-561. [PMID: 33040337 PMCID: PMC7675426 DOI: 10.1111/all.14622] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/09/2020] [Accepted: 09/21/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND The missing asymptomatic COVID-19 infections have been overlooked because of the imperfect sensitivity of the nucleic acid testing (NAT). Globally understanding the humoral immunity in asymptomatic carriers will provide scientific knowledge for developing serological tests, improving early identification, and implementing more rational control strategies against the pandemic. MEASURE Utilizing both NAT and commercial kits for serum IgM and IgG antibodies, we extensively screened 11 766 epidemiologically suspected individuals on enrollment and 63 asymptomatic individuals were detected and recruited. Sixty-three healthy individuals and 51 mild patients without any preexisting conditions were set as controls. Serum IgM and IgG profiles were further probed using a SARS-CoV-2 proteome microarray, and neutralizing antibody was detected by a pseudotyped virus neutralization assay system. The dynamics of antibodies were analyzed with exposure time or symptoms onset. RESULTS A combination test of NAT and serological testing for IgM antibody discovered 55.5% of the total of 63 asymptomatic infections, which significantly raises the detection sensitivity when compared with the NAT alone (19%). Serum proteome microarray analysis demonstrated that asymptomatics mainly produced IgM and IgG antibodies against S1 and N proteins out of 20 proteins of SARS-CoV-2. Different from strong and persistent N-specific antibodies, S1-specific IgM responses, which evolved in asymptomatic individuals as early as the seventh day after exposure, peaked on days from 17 days to 25 days, and then disappeared in two months, might be used as an early diagnostic biomarker. 11.8% (6/51) mild patients and 38.1% (24/63) asymptomatic individuals did not produce neutralizing antibody. In particular, neutralizing antibody in asymptomatics gradually vanished in two months. CONCLUSION Our findings might have important implications for the definition of asymptomatic COVID-19 infections, diagnosis, serological survey, public health, and immunization strategies.
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Affiliation(s)
- Qing Lei
- Department of Pathogen Biology School of Basic Medicine Tongji Medical CollegeHuazhong University of Science and Technology Wuhan China
| | - Yang Li
- Shanghai Center for Systems Biomedicine Key Laboratory of Systems Biomedicine (Ministry of Education) Shanghai Jiao Tong University Shanghai China
| | - Hong‐yan Hou
- Department of Laboratory Medicine Tongji HospitalTongji Medical CollegeHuazhong University of Science and Technology Wuhan China
| | - Feng Wang
- Department of Laboratory Medicine Tongji HospitalTongji Medical CollegeHuazhong University of Science and Technology Wuhan China
| | - Zhu‐qing Ouyang
- Department of Pathogen Biology School of Basic Medicine Tongji Medical CollegeHuazhong University of Science and Technology Wuhan China
| | - Yandi Zhang
- Department of Pathogen Biology School of Basic Medicine Tongji Medical CollegeHuazhong University of Science and Technology Wuhan China
| | - Dan‐yun Lai
- Shanghai Center for Systems Biomedicine Key Laboratory of Systems Biomedicine (Ministry of Education) Shanghai Jiao Tong University Shanghai China
| | - Jo‐Lewis Banga Ndzouboukou
- Department of Pathogen Biology School of Basic Medicine Tongji Medical CollegeHuazhong University of Science and Technology Wuhan China
| | - Zhao‐wei Xu
- Shanghai Center for Systems Biomedicine Key Laboratory of Systems Biomedicine (Ministry of Education) Shanghai Jiao Tong University Shanghai China
| | - Bo Zhang
- Department of Laboratory Medicine Tongji HospitalTongji Medical CollegeHuazhong University of Science and Technology Wuhan China
| | - Hong Chen
- Shanghai Center for Systems Biomedicine Key Laboratory of Systems Biomedicine (Ministry of Education) Shanghai Jiao Tong University Shanghai China
| | - Jun‐biao Xue
- Shanghai Center for Systems Biomedicine Key Laboratory of Systems Biomedicine (Ministry of Education) Shanghai Jiao Tong University Shanghai China
| | - Xiao‐song Lin
- Department of Pathogen Biology School of Basic Medicine Tongji Medical CollegeHuazhong University of Science and Technology Wuhan China
| | - Yun‐xiao Zheng
- Shanghai Center for Systems Biomedicine Key Laboratory of Systems Biomedicine (Ministry of Education) Shanghai Jiao Tong University Shanghai China
| | - Zong‐jie Yao
- Department of Pathogen Biology School of Basic Medicine Tongji Medical CollegeHuazhong University of Science and Technology Wuhan China
| | - Xue‐ning Wang
- Shanghai Center for Systems Biomedicine Key Laboratory of Systems Biomedicine (Ministry of Education) Shanghai Jiao Tong University Shanghai China
| | - Cai‐zheng Yu
- Department of Public Health Tongji HospitalTongji Medical CollegeHuazhong University of Science and Technology Wuhan China
| | - He‐wei Jiang
- Shanghai Center for Systems Biomedicine Key Laboratory of Systems Biomedicine (Ministry of Education) Shanghai Jiao Tong University Shanghai China
| | - Hai‐nan Zhang
- Shanghai Center for Systems Biomedicine Key Laboratory of Systems Biomedicine (Ministry of Education) Shanghai Jiao Tong University Shanghai China
| | - Huan Qi
- Shanghai Center for Systems Biomedicine Key Laboratory of Systems Biomedicine (Ministry of Education) Shanghai Jiao Tong University Shanghai China
| | - Shu‐juan Guo
- Shanghai Center for Systems Biomedicine Key Laboratory of Systems Biomedicine (Ministry of Education) Shanghai Jiao Tong University Shanghai China
| | - Sheng‐hai Huang
- Department of Microbiology School of Basic Medical Sciences Anhui Medical University Hefei China
| | - Zi‐yong Sun
- Department of Laboratory Medicine Tongji HospitalTongji Medical CollegeHuazhong University of Science and Technology Wuhan China
| | - Sheng‐ce Tao
- Shanghai Center for Systems Biomedicine Key Laboratory of Systems Biomedicine (Ministry of Education) Shanghai Jiao Tong University Shanghai China
| | - Xiong‐lin Fan
- Department of Pathogen Biology School of Basic Medicine Tongji Medical CollegeHuazhong University of Science and Technology Wuhan China
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Galanis P, Vraka I, Fragkou D, Bilali A, Kaitelidou D. Seroprevalence of SARS-CoV-2 antibodies and associated factors in healthcare workers: a systematic review and meta-analysis. J Hosp Infect 2021; 108:120-134. [PMID: 33212126 PMCID: PMC7668234 DOI: 10.1016/j.jhin.2020.11.008] [Citation(s) in RCA: 217] [Impact Index Per Article: 72.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/10/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Healthcare workers (HCWs) represent a high-risk population for infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). AIM To determine the seroprevalence of SARS-CoV-2 antibodies among HCWs, and identify the factors associated with this seroprevalence. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were applied for this systematic review and meta-analysis. Databases including PubMed/MEDLINE and preprint services (medRχiv and bioRχiv) were searched from inception to 24th August 2020. FINDINGS Forty-nine studies including 127,480 HCWs met the inclusion criteria. The estimated overall seroprevalence of SARS-CoV-2 antibodies among HCWs was 8.7% (95% confidence interval 6.7-10.9%). Seroprevalence was higher in studies conducted in North America (12.7%) compared with those conducted in Europe (8.5%), Africa (8.2) and Asia (4%). Meta-regression showed that increased sensitivity of antibody tests was associated with increased seroprevalence. The following factors were associated with seropositivity: male gender; Black, Asian and Hispanic HCWs; work in a coronavirus disease 2019 (COVID-19) unit; patient-related work; front-line HCWs; healthcare assistants; shortage of personal protective equipment; self-reported belief of previous SARS-CoV-2 infection; previous positive polymerase chain reaction test; and household contact with suspected or confirmed cases of COVID-19. CONCLUSION The seroprevalence of SARS-CoV-2 antibodies among HCWs is high. Excellent adherence to infection prevention and control measures; sufficient and adequate personal protective equipment; and early recognition, identification and isolation of HCWs infected with SARS-CoV-2 are imperative to decrease the risk of SARS-CoV-2 infection.
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Affiliation(s)
- P Galanis
- Faculty of Nursing, Centre for Health Services Management and Evaluation, National and Kapodistrian University of Athens, Athens, Greece.
| | - I Vraka
- Department of Radiology, P & A Kyriakou Children's Hospital, Athens, Greece
| | - D Fragkou
- Faculty of Nursing, Centre for Health Services Management and Evaluation, National and Kapodistrian University of Athens, Athens, Greece
| | - A Bilali
- Hospital Waste Management Unit, P & A Kyriakou Children's Hospital, Athens, Greece
| | - D Kaitelidou
- Faculty of Nursing, Centre for Health Services Management and Evaluation, National and Kapodistrian University of Athens, Athens, Greece
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Sisay A, Tesfaye A, Desale A, Ataro I, Woldesenbet Z, Nigusse B, Tayachew A, Kebede A, Desta AF. Diagnostic Performance of SARS-CoV-2 IgM/IgG Rapid Test Kits for the Detection of the Novel Coronavirus in Ethiopia. J Multidiscip Healthc 2021; 14:171-180. [PMID: 33536760 PMCID: PMC7850445 DOI: 10.2147/jmdh.s290711] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/22/2020] [Indexed: 12/24/2022] Open
Abstract
Purpose Rapid severe acute respiratory syndrome coronavirus 2 test kits are crucial for bridging diagnostic gaps in health facilities and community screening mainly in resource limited settings. However, there is no objective evidence on their diagnostic performance. Thus, the study aimed to evaluate comparative diagnostic performance of three selected SARS-CoV-2 IgG/IgM rapid test kits in Ethiopia. Methods A cross-sectional study was conducted among 200 clients between May and July 2020 in Addis Ababa, Ethiopia. The performance of three SARS-CoV-2 rapid test kits EGENE, CTK BIOTECKs Onsite, and ACON Biotech were evaluated using blood specimens against RT-PCR on respiratory swabs. Sensitivity, specificity, and agreement with each other and to RT-PCR were computed using Vassarstats, MedCalc and SPSS version 23 statistical software. Results Test kits showed a heterogeneous comparative diagnostic performance in their sensitivity and specificity. The sensitivity was 61.18% (95% CI: 49.96–71.37%), 74.12% (95% CI: 63.28–82.74%) and 83.53% (95% CI: 73.57–90.38%) for kit A, B and C, respectively. Similarly, the specificity was 96.52% (90.81–98.88%), 94.78% (88.52–97.86%) and 94.78% (88.52–97.86%) for test kit A, B and C, respectively. The test kits have an agreement with RT-PCR with kappa value of 0.60 (0.48–0.83), 0.71 (0.65–0.93), and 0.80 (0.76–1.04) for A, B, and C, respectively. There was a significant difference on diagnostic performance among the three test kits and PCR with a p-value < 0.001 Cochran’s Q test. Conclusion The diagnostic performance of the test kits was promising and recommended for COVID-19 diagnostics in combination with RT-PCR to detect more infected patients. It allows determining the seroprevalence of the virus and true extent of SARS-COV-2 community spread in resource limited settings. We underline countries to evaluate rapid diagnostic test kits before diagnostic use.
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Affiliation(s)
- Abay Sisay
- Department of Microbial Cellular and Molecular Biology, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abraham Tesfaye
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Diagnostic Unit, Center for Innovative Drug Development and Therapeutic Trials for Africa, CDT-Africa, Addis Ababa, Ethiopia
| | - Adino Desale
- National Laboratories Capacity Building Directorate, Ethiopian Public Health Institutes, EPHI, Addis Ababa, Ethiopia
| | - Israel Ataro
- Health Extension Program and Primary Health Care Directorate, Federal Democratic Republic of Ethiopia, Ministry of Health, Addis Ababa, Ethiopia
| | - Zerihun Woldesenbet
- Department of Medical Laboratory, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
| | - Bisrat Nigusse
- Program Management Unit, Ethiopian Public Health Laboratory Association, Addis Ababa, Ethiopia
| | - Adamu Tayachew
- National Laboratories Capacity Building Directorate, Ethiopian Public Health Institutes, EPHI, Addis Ababa, Ethiopia.,National Influenza and Arbovirus Reference Laboratory, Ethiopian Public Health Institutes, EPHI, Addis Ababa, Ethiopia
| | - Adisu Kebede
- National Laboratories Capacity Building Directorate, Ethiopian Public Health Institutes, EPHI, Addis Ababa, Ethiopia
| | - Adey F Desta
- Department of Microbial Cellular and Molecular Biology, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Mostafa A, Kandil S, El-Sayed MH, Girgis S, Hafez H, Yosef M, Saber S, Ezzelarab H, Ramadan M, Algohary E, Fahmy G, Afifi I, Hassan F, Elsayed S, Reda A, Fattuh D, Mahmoud A, Mansour A, Sabry M, Habeb P, Ebeid FS, Elanwar A, Saleh A, Mansour O, Omar A, El-Meteini M. SARS-CoV-2 seroconversion among 4040 Egyptian healthcare workers in 12 resource-limited healthcare facilities: A prospective cohort study. Int J Infect Dis 2021; 104:534-542. [PMID: 33484863 PMCID: PMC7817419 DOI: 10.1016/j.ijid.2021.01.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/31/2020] [Accepted: 01/10/2021] [Indexed: 12/21/2022] Open
Abstract
Background We examined Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) seroconversion incidence and risk factors 21 days after baseline screening among healthcare workers (HCWs) in a resource-limited setting. Methods A prospective cohort study of 4040 HCWs took place at 12 university healthcare facilities in Cairo, Egypt; April-June 2020. Follow-up exposure and clinical data were collected through online survey. SARS-CoV-2 testing was done using rapid IgM and IgG serological tests and reverse transcriptase–polymerase chain reaction (RT-PCR) for those with positive serology. Cox proportional hazards modelling was used to estimate adjusted hazard ratios (HR) of seroconversion. Results 3870/4040 (95.8%) HCWs tested negative for IgM, IgG and PCR at baseline; 2282 (59.0%) returned for 21-day follow-up. Seroconversion incidence (positive IgM and/or IgG) was 100/2282 (4.4%, 95% CI:3.6-5.3), majority asymptomatic (64.0%); daily hazard of 0.21% (95% CI:0.17-0.25)/48 746 person-days of follow-up. Seroconversion was: 4.0% (64/1596; 95% CI:3.1-5.1) among asymptomatic; 5.3% (36/686; 95% CI:3.7-7.2) among symptomatic HCWs. Seroconversion was independently associated with older age; lower education; contact with a confirmed case >15 min; chronic kidney disease; pregnancy; change/loss of smell; and negatively associated with workplace contact. Conclusions Most seroconversions were asymptomatic, emphasizing need for regular universal testing. Seropositivity was three-fold that observed at baseline. Cumulative infections increased nationally by a similar rate, suggesting HCW infections reflect community not nosocomial transmission.
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Affiliation(s)
- Aya Mostafa
- Department of Community, Environmental, and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - Sahar Kandil
- Department of Community, Environmental, and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Manal H El-Sayed
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt; Clinical Research Center (MASRI-CRC), Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Samia Girgis
- Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hala Hafez
- Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mostafa Yosef
- Department of Community, Environmental, and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Saly Saber
- Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hoda Ezzelarab
- Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Marwa Ramadan
- Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Eman Algohary
- Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt; Ain Shams University Specialized Hospitals, Egypt
| | - Gehan Fahmy
- Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt; Ain Shams University Specialized Hospitals, Egypt
| | - Iman Afifi
- Infection Control Unit, Ain Shams University Hospitals, Cairo, Egypt
| | | | - Shaimaa Elsayed
- Infection Control Unit, Ain Shams University Hospitals, Cairo, Egypt
| | - Amira Reda
- Infection Control Unit, Ain Shams University Hospitals, Cairo, Egypt
| | - Doaa Fattuh
- Infection Control Unit, Ain Shams University Hospitals, Cairo, Egypt
| | - Asmaa Mahmoud
- Infection Control Unit, Ain Shams University Hospitals, Cairo, Egypt
| | - Amany Mansour
- Infection Control Unit, Ain Shams University Hospitals, Cairo, Egypt
| | - Moshira Sabry
- Infection Control Unit, Ain Shams University Hospitals, Cairo, Egypt
| | - Petra Habeb
- Infection Control Unit, Ain Shams University Hospitals, Cairo, Egypt
| | - Fatma Se Ebeid
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt; Clinical Research Center (MASRI-CRC), Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ali Elanwar
- Ain Shams University Specialized Hospitals, Egypt; Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ayman Saleh
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ossama Mansour
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ashraf Omar
- Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mahmoud El-Meteini
- Department of Hepatobiliary Surgery & Liver Transplantation, Ain Shams Center for Organ Transplantation (ASCOT), Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Goldblatt D, Johnson M, Falup-Pecurariu O, Ivaskeviciene I, Spoulou V, Tamm E, Wagner M, Zar HJ, Bleotu L, Ivaskevicius R, Papadatou I, Jõgi P, Lischka J, Franckling-Smith Z, Isarova D, Grandjean L, Zavadska D. Cross-sectional prevalence of SARS-CoV-2 antibodies in healthcare workers in paediatric facilities in eight countries. J Hosp Infect 2021; 110:60-66. [PMID: 33422589 PMCID: PMC7836791 DOI: 10.1016/j.jhin.2020.12.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/24/2020] [Accepted: 12/26/2020] [Indexed: 12/11/2022]
Abstract
Background Healthcare workers (HCWs) have been disproportionately affected by coronavirus disease 2019 (COVID-19), which may be driven, in part, by nosocomial exposure. If HCW exposure is predominantly nosocomial, HCWs in paediatric facilities, where few patients are admitted with COVID-19, may lack antibodies to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and be at increased risk during the current resurgence. Aim To compare the seroprevalence of SARS-CoV-2 amongst HCWs in paediatric facilities in seven European countries and South Africa (N=8). Methods All categories of paediatric HCWs were invited to participate in the study, irrespective of previous symptoms. A single blood sample was taken and data about previous symptoms were documented. Serum was shipped to a central laboratory in London where SARS-CoV-2 immunoglobulin G was measured. Findings In total, 4114 HCWs were recruited between 1st May and mid-July 2020. The range of seroprevalence was 0–16.93%. The highest seroprevalence was found in London (16.93%), followed by Cape Town, South Africa (10.36%). There were no positive HCWs in the Austrian, Estonian and Latvian cohorts; 2/300 [0.66%, 95% confidence interval (CI) 0.18–2.4] HCWs tested positive in Lithuania; 1/124 (0.81%, 95% CI 0.14–4.3) HCWs tested positive in Romania; and 1/76 (1.3%, 95% CI 0.23–7.0) HCWs tested positive in Greece. Conclusion Overall seroprevalence amongst paediatric HCWs is similar to their national populations and linked to the national COVID-19 burden. Staff working in paediatric facilities in low-burden countries have very low seroprevalence rates and thus are likely to be susceptible to COVID-19. Their susceptibility to infection may affect their ability to provide care in the face of increasing cases of COVID-19, and this highlights the need for appropriate preventative strategies in paediatric healthcare settings.
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Affiliation(s)
- D Goldblatt
- Great Ormond Street Institute of Child Health, University College London, London, UK; Great Ormond Street Children's Hospital NHS Foundation Trust, London, UK.
| | - M Johnson
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - O Falup-Pecurariu
- Children's Clinic Hospital, Faculty of Medicine, Transilvania University, Brasov, Romania
| | - I Ivaskeviciene
- Paediatric Centre, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - V Spoulou
- 'Agia Sophia' Children's Hospital of Athens, Athens, Greece
| | - E Tamm
- Children's Clinic of Tartu University Hospital, Tartu, Estonia
| | - M Wagner
- Division of Neonatology, Paediatric Intensive Care and Neuropaediatrics, Department of Paediatrics, Comprehensive Centre for Paediatrics, Medical University of Vienna, Vienna, Austria
| | - H J Zar
- Department of Paediatrics and Child Health, Red Cross Children's Hospital, and SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - L Bleotu
- Children's Clinic Hospital, Faculty of Medicine, Transilvania University, Brasov, Romania
| | - R Ivaskevicius
- Paediatric Centre, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - I Papadatou
- Immunobiology and Vaccinology Research Laboratory, National and Kapodistrian University of Athens, Athens, Greece
| | - P Jõgi
- Children's Clinic of Tartu University Hospital, Tartu, Estonia
| | - J Lischka
- Clinical Division of Paediatric Pulmonology, Allergology and Endocrinology, Department of Paediatrics and Adolescent Medicine, Comprehensive Centre for Paediatrics, Medical University of Vienna, Vienna, Austria
| | - Z Franckling-Smith
- Department of Paediatrics and Child Health, Red Cross Children's Hospital, and SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - D Isarova
- Children's Clinical University Hospital, Riga, Latvia
| | - L Grandjean
- Great Ormond Street Institute of Child Health, University College London, London, UK; Great Ormond Street Children's Hospital NHS Foundation Trust, London, UK
| | - D Zavadska
- Children's Clinical University Hospital, Riga, Latvia
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Brüssow H. COVID-19 by numbers - infections, cases and deaths. Environ Microbiol 2021; 23:1322-1333. [PMID: 33368993 DOI: 10.1111/1462-2920.15377] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 12/22/2020] [Indexed: 01/28/2023]
Abstract
During the COVID-19 pandemic, governments face difficult decisions when being confronted with public health threats and economic needs. Decision making is further complicated by the different perception of the pandemic by the public. Politicians as well as the public need objective facts for guidance and numbers play here a crucial role. The current contribution compiles numbers for infections, cases and deaths with SARS-CoV-2 to serve as an orientation help.
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Affiliation(s)
- Harald Brüssow
- Department of Biosystems, Laboratory of Gene Technology, KU Leuven, Leuven, Belgium
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Kumar Goenka M, Bharat Shah B, Goenka U, Das SS, Afzalpurkar S, Mukherjee M, Patil VU, Jajodia S, Rodge GA, Khan U, Bandopadhyay S. COVID-19 prevalence among health-care workers of Gastroenterology department: An audit from a tertiary-care hospital in India. JGH Open 2021; 5:56-63. [PMID: 33490614 PMCID: PMC7812452 DOI: 10.1002/jgh3.12447] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIM In the present coronavirus disease-19 (COVID-19) era, health-care workers (HCWs) warrant special attention because of their higher risk and potential to transmit the disease. Gastroenterology services include emergency and critical care along with the endoscopy procedures, which have aerosol-generating potential. This study was aimed at auditing the COVID-19 impact on HCWs working in the Gastroenterology department of our hospital. METHODS The COVID-19 status of 117 HCWs was collected using either polymerase chain reaction (PCR) or Immunoglobulin G (IgG) seroassay. COVID-19 positivity was correlated with demographic characteristics, job profile, area of work, and medical history. RESULTS Thirty-eight HCWs (32.48%) showed evidence of COVID-19 using PCR (23.93%) or only IgG assay (8.55%). Endoscopy technicians (68.75%) exhibited significantly higher (P = 0.003) COVID-19 incidence compared to doctors (20.69%). Those working in the critical care units exhibited a trend toward higher COVID-19 incidence (42.86%). None of the six HCWs who received adequate hydroxychloroquine prophylaxis developed evidence of COVID-19. All the HCWs with COVID-19 disease recovered. However, there was a considerable loss of "man-days." CONCLUSIONS In our setting, we observed a high COVID-19 risk for HCWs working in the Gastroenterology department, with the highest risk among the endoscopy technicians. A more stringent triaging and pretesting of patients, as well as HCWs, might decrease the risk of COVID-19. Further multicenter studies are needed to evaluate the risk and related parameters.
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Affiliation(s)
- Mahesh Kumar Goenka
- Institute of Gastrosciences and LiverApollo Gleneagles HospitalsKolkataIndia
| | - Bhavik Bharat Shah
- Institute of Gastrosciences and LiverApollo Gleneagles HospitalsKolkataIndia
| | - Usha Goenka
- Department of Clinical Imaging and Interventional RadiologyApollo Gleneagles HospitalsKolkataIndia
| | - Sudipto S Das
- Department of Transfusion Medicine and Blood BankApollo Gleneagles HospitalsKolkataIndia
| | | | - Mohuya Mukherjee
- Department of BiostatisticsApollo Gleneagles HospitalsKolkataIndia
| | - Vikram U Patil
- Institute of Gastrosciences and LiverApollo Gleneagles HospitalsKolkataIndia
| | - Surabhi Jajodia
- Department of Clinical Imaging and Interventional RadiologyApollo Gleneagles HospitalsKolkataIndia
| | - Gajanan A. Rodge
- Institute of Gastrosciences and LiverApollo Gleneagles HospitalsKolkataIndia
| | - Ujjaini Khan
- Department of MicrobiologyApollo Gleneagles HospitalsKolkataIndia
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Rasmi Y, Li X, Khan J, Ozer T, Choi JR. Emerging point-of-care biosensors for rapid diagnosis of COVID-19: current progress, challenges, and future prospects. Anal Bioanal Chem 2021; 413:4137-4159. [PMID: 34008124 PMCID: PMC8130795 DOI: 10.1007/s00216-021-03377-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 04/26/2021] [Indexed: 02/07/2023]
Abstract
Coronavirus disease 2019 (COVID-19) pandemic is currently a serious global health threat. While conventional laboratory tests such as quantitative real-time polymerase chain reaction (qPCR), serology tests, and chest computerized tomography (CT) scan allow diagnosis of COVID-19, these tests are time-consuming and laborious, and are limited in resource-limited settings or developing countries. Point-of-care (POC) biosensors such as chip-based and paper-based biosensors are typically rapid, portable, cost-effective, and user-friendly, which can be used for COVID-19 in remote settings. The escalating demand for rapid diagnosis of COVID-19 presents a strong need for a timely and comprehensive review on the POC biosensors for COVID-19 that meet ASSURED criteria: Affordable, Sensitive, Specific, User-friendly, Rapid and Robust, Equipment-free, and Deliverable to end users. In the present review, we discuss the importance of rapid and early diagnosis of COVID-19 and pathogenesis of COVID-19 along with the key diagnostic biomarkers. We critically review the most recent advances in POC biosensors which show great promise for the detection of COVID-19 based on three main categories: chip-based biosensors, paper-based biosensors, and other biosensors. We subsequently discuss the key benefits of these biosensors and their use for the detection of antigen, antibody, and viral nucleic acids. The commercial POC biosensors for COVID-19 are critically compared. Finally, we discuss the key challenges and future perspectives of developing emerging POC biosensors for COVID-19. This review would be very useful for guiding strategies for developing and commercializing rapid POC tests to manage the spread of infections.Graphical abstract.
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Affiliation(s)
- Yousef Rasmi
- Department of Biochemistry, Faculty of Medicine, Urmia University of Medical Sciences, 5714783734, Urmia, Iran ,Cellular and Molecular Research Center, Urmia University of Medical Sciences, 5714783734, Urmia, Iran
| | - Xiaokang Li
- Ludwig Institute for Cancer Research, University of Lausanne, Agora Center, 1005 Lausanne, Switzerland ,Department of Oncology, Centre hospitalier universitaire vaudois (CHUV), 1011 Lausanne, Switzerland
| | - Johra Khan
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Majmaah University, Majmaah, 11952 Kingdom of Saudi Arabia
| | - Tugba Ozer
- Department of Bioengineering, Faculty of Chemical-Metallurgical Engineering, Yildiz Technical University, 34220 Istanbul, Turkey
| | - Jane Ru Choi
- Department of Mechanical Engineering, University of British Columbia, Vancouver, BC V6T 1Z4 Canada ,Centre for Blood Research, Life Sciences Centre, University of British Columbia, Vancouver, BC V6T 1Z3 Canada
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Ladds E, Rushforth A, Wieringa S, Taylor S, Rayner C, Husain L, Greenhalgh T. Persistent symptoms after Covid-19: qualitative study of 114 "long Covid" patients and draft quality principles for services. BMC Health Serv Res 2020; 20:1144. [PMID: 33342437 DOI: 10.1101/2020.10.13.20211854] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/08/2020] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Approximately 10% of patients with Covid-19 experience symptoms beyond 3-4 weeks. Patients call this "long Covid". We sought to document such patients' lived experience, including accessing and receiving healthcare and ideas for improving services. METHODS We held 55 individual interviews and 8 focus groups (n = 59) with people recruited from UK-based long Covid patient support groups, social media and snowballing. We restricted some focus groups to health professionals since they had already self-organised into online communities. Participants were invited to tell their stories and comment on others' stories. Data were audiotaped, transcribed, anonymised and coded using NVIVO. Analysis incorporated sociological theories of illness, healing, peer support, clinical relationships, access, and service redesign. RESULTS Of 114 participants aged 27-73 years, 80 were female. Eighty-four were White British, 13 Asian, 8 White Other, 5 Black, and 4 mixed ethnicity. Thirty-two were doctors and 19 other health professionals. Thirty-one had attended hospital, of whom 8 had been admitted. Analysis revealed a confusing illness with many, varied and often relapsing-remitting symptoms and uncertain prognosis; a heavy sense of loss and stigma; difficulty accessing and navigating services; difficulty being taken seriously and achieving a diagnosis; disjointed and siloed care (including inability to access specialist services); variation in standards (e.g. inconsistent criteria for seeing, investigating and referring patients); variable quality of the therapeutic relationship (some participants felt well supported while others felt "fobbed off"); and possible critical events (e.g. deterioration after being unable to access services). Emotionally significant aspects of participants' experiences informed ideas for improving services. CONCLUSION Suggested quality principles for a long Covid service include ensuring access to care, reducing burden of illness, taking clinical responsibility and providing continuity of care, multi-disciplinary rehabilitation, evidence-based investigation and management, and further development of the knowledge base and clinical services. TRIAL REGISTRATION NCT04435041.
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Affiliation(s)
- Emma Ladds
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Alex Rushforth
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Sietse Wieringa
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Sharon Taylor
- Central and North West London NHS Foundation Trust, London, UK
- Imperial College School of Medicine, London, UK
| | - Clare Rayner
- Independent Occupational Physician, Manchester, UK
| | - Laiba Husain
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK.
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Persistent symptoms after Covid-19: qualitative study of 114 "long Covid" patients and draft quality principles for services. BMC Health Serv Res 2020; 20:1144. [PMID: 33342437 PMCID: PMC7750006 DOI: 10.1186/s12913-020-06001-y] [Citation(s) in RCA: 329] [Impact Index Per Article: 82.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/08/2020] [Indexed: 01/18/2023] Open
Abstract
Background Approximately 10% of patients with Covid-19 experience symptoms beyond 3–4 weeks. Patients call this “long Covid”. We sought to document such patients’ lived experience, including accessing and receiving healthcare and ideas for improving services. Methods We held 55 individual interviews and 8 focus groups (n = 59) with people recruited from UK-based long Covid patient support groups, social media and snowballing. We restricted some focus groups to health professionals since they had already self-organised into online communities. Participants were invited to tell their stories and comment on others’ stories. Data were audiotaped, transcribed, anonymised and coded using NVIVO. Analysis incorporated sociological theories of illness, healing, peer support, clinical relationships, access, and service redesign. Results Of 114 participants aged 27–73 years, 80 were female. Eighty-four were White British, 13 Asian, 8 White Other, 5 Black, and 4 mixed ethnicity. Thirty-two were doctors and 19 other health professionals. Thirty-one had attended hospital, of whom 8 had been admitted. Analysis revealed a confusing illness with many, varied and often relapsing-remitting symptoms and uncertain prognosis; a heavy sense of loss and stigma; difficulty accessing and navigating services; difficulty being taken seriously and achieving a diagnosis; disjointed and siloed care (including inability to access specialist services); variation in standards (e.g. inconsistent criteria for seeing, investigating and referring patients); variable quality of the therapeutic relationship (some participants felt well supported while others felt “fobbed off”); and possible critical events (e.g. deterioration after being unable to access services). Emotionally significant aspects of participants’ experiences informed ideas for improving services. Conclusion Suggested quality principles for a long Covid service include ensuring access to care, reducing burden of illness, taking clinical responsibility and providing continuity of care, multi-disciplinary rehabilitation, evidence-based investigation and management, and further development of the knowledge base and clinical services. Trial registration NCT04435041.
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Galipeau Y, Greig M, Liu G, Driedger M, Langlois MA. Humoral Responses and Serological Assays in SARS-CoV-2 Infections. Front Immunol 2020; 11:610688. [PMID: 33391281 PMCID: PMC7775512 DOI: 10.3389/fimmu.2020.610688] [Citation(s) in RCA: 162] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 11/23/2020] [Indexed: 12/14/2022] Open
Abstract
In December 2019, the novel betacoronavirus Severe Acute Respiratory Disease Coronavirus 2 (SARS-CoV-2) was first detected in Wuhan, China. SARS-CoV-2 has since become a pandemic virus resulting in hundreds of thousands of deaths and deep socioeconomic implications worldwide. In recent months, efforts have been directed towards detecting, tracking, and better understanding human humoral responses to SARS-CoV-2 infection. It has become critical to develop robust and reliable serological assays to characterize the abundance, neutralization efficiency, and duration of antibodies in virus-exposed individuals. Here we review the latest knowledge on humoral immune responses to SARS-CoV-2 infection, along with the benefits and limitations of currently available commercial and laboratory-based serological assays. We also highlight important serological considerations, such as antibody expression levels, stability and neutralization dynamics, as well as cross-reactivity and possible immunological back-boosting by seasonal coronaviruses. The ability to accurately detect, measure and characterize the various antibodies specific to SARS-CoV-2 is necessary for vaccine development, manage risk and exposure for healthcare and at-risk workers, and for monitoring reinfections with genetic variants and new strains of the virus. Having a thorough understanding of the benefits and cautions of standardized serological testing at a community level remains critically important in the design and implementation of future vaccination campaigns, epidemiological models of immunity, and public health measures that rely heavily on up-to-date knowledge of transmission dynamics.
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Affiliation(s)
- Yannick Galipeau
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON, Canada
| | - Matthew Greig
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON, Canada
| | - George Liu
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON, Canada
| | | | - Marc-André Langlois
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON, Canada
- uOttawa Center for Infection, Immunity and Inflammation (CI3), Ottawa, ON, Canada
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Mahshid SS, Flynn SE, Mahshid S. The potential application of electrochemical biosensors in the COVID-19 pandemic: A perspective on the rapid diagnostics of SARS-CoV-2. Biosens Bioelectron 2020; 176:112905. [PMID: 33358285 PMCID: PMC7746140 DOI: 10.1016/j.bios.2020.112905] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/11/2020] [Accepted: 12/13/2020] [Indexed: 12/13/2022]
Abstract
Electrochemical biosensors combine the selectivity of electrochemical signal transducers with the specificity of biomolecular recognition strategies. Although they have been broadly studied in different areas of diagnostics, they are not yet fully commercialized. During the COVID-19 pandemic, electrochemical platforms have shown the potential to address significant limitations of conventional diagnostic platforms, including accuracy, affordability, and portability. The advantages of electrochemical platforms make them a strong candidate for rapid point-of-care detection of SARS-CoV-2 infection by targeting not only viral RNA but antigens and antibodies. Herein, we reviewed advancements in electrochemical biosensing platforms towards the detection of SARS-CoV-2 through studying similar viruses. The complicated nature of conventional tests restricted the availability and distribution of COVID-19 tests. Electrochemical detection methods can stand as potential rapid tests for the diagnosis of COVID-19. Electrochemical biosensors combine signal selectivity and molecular specificity for rapid accurate detection of SARS-CoV-2. The electrochemical biosensors demonstrate trail-blazing sensitivity and specificity, outmatching conventional assays.
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Affiliation(s)
- Sahar Sadat Mahshid
- Biological Sciences Department, Sunnybrook Research Institute, Toronto, ON, M4N 3M5, Canada.
| | | | - Sara Mahshid
- Department of Bioengineering, McGill University, Montréal, QC, H3A 0C3, Canada.
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Murakami E, Ghatak-Roy A, Popova M, Gannon C, Park DE, Villani J, Liu C, Toma I, Lafleur J. COVID-19 infection among emergency department healthcare providers in a large tertiary academic medical center following the peak of the pandemic. Am J Emerg Med 2020; 40:27-31. [PMID: 33340874 PMCID: PMC7708800 DOI: 10.1016/j.ajem.2020.11.064] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 11/20/2020] [Accepted: 11/25/2020] [Indexed: 12/01/2022] Open
Abstract
The COVID-19 pandemic has spread through the US during the last few months exposing healthcare providers to possible infection. Here we report testing of emergency department (ED) healthcare providers (HCP) for exposure to COVID-19 through lateral flow point of care (POC) and lab-based enzyme-linked immunosorbent assay (ELISA), and RTq-PCR for evidence of acute infection. 138 ED HCP were tested between May 26th (approximately one month after the peak of COVID-19 first wave of cases) and June 14th. Enrolled ED HCP represented about 70% of the total ED HCP workforce during the study period. Subjects were tested with a POC COVID-19 antibody test, and standard ELISA performed by a university-based research lab. Subjects also provided a mid-turbinate swab and a saliva specimen for RTq-PCR. All subjects provided demographic information, past medical history, information about personal protective equipment (PPE) use, COVID-19 symptoms, as well as potential COVID-19 exposures during the previous 4 weeks, both in the ED, and outside the clinical setting. None of the HCP had positive RT-PCR results; 7 HCP (5%) had positive IgG for COVID-19; there was strong agreement between the lab-based ELISA (reference test) and the POC Ab test (P ≤ 0.0001). For the POC Ab test there were no false negatives and only one false positive among the 138 participants. There was no significant difference in demographic/ethnic variables, past medical history, hours worked in the ED, PPE use, or concerning exposures between seropositive and seronegative individuals. Moreover, there was no significant difference in reported symptoms between the two groups during the previous four weeks. The rate of COVID-19 seroconversion in our ED was 5% during the month following the pandemic's first wave. Based on questionnaire responses, differences in demographics/ethnicity, medical history, COVID-19 exposures, and PPE use were not associated with ED HCP having been infected with SARS-CoV-2. In the setting of our limited cohort of subjects the COVID-19 POC Ab test performed comparably to the ELISA lab-based standard.
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Affiliation(s)
- Eric Murakami
- Department Emergency Medicine, George Washington University School of Medicine, Washington, DC, USA
| | - Aditi Ghatak-Roy
- Department Emergency Medicine, George Washington University School of Medicine, Washington, DC, USA
| | - Margarita Popova
- Department Emergency Medicine, George Washington University School of Medicine, Washington, DC, USA
| | - Carin Gannon
- Department Emergency Medicine, George Washington University School of Medicine, Washington, DC, USA
| | - Daniel E Park
- Department of Environmental and Occupational Health, George Washington University School of Public Health, Washington, DC, USA
| | - Jack Villani
- Department of Environmental and Occupational Health, George Washington University School of Public Health, Washington, DC, USA
| | - Cindy Liu
- Department of Environmental and Occupational Health, George Washington University School of Public Health, Washington, DC, USA
| | - Ian Toma
- Department Genomic Medicine, George Washington University School of Medicine, Washington, DC, USA
| | - John Lafleur
- Department Emergency Medicine, George Washington University School of Medicine, Washington, DC, USA.
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Molenberghs G, Buyse M, Abrams S, Hens N, Beutels P, Faes C, Verbeke G, Van Damme P, Goossens H, Neyens T, Herzog S, Theeten H, Pepermans K, Abad AA, Van Keilegom I, Speybroeck N, Legrand C, De Buyser S, Hulstaert F. Infectious diseases epidemiology, quantitative methodology, and clinical research in the midst of the COVID-19 pandemic: Perspective from a European country. Contemp Clin Trials 2020; 99:106189. [PMID: 33132155 PMCID: PMC7581408 DOI: 10.1016/j.cct.2020.106189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 10/04/2020] [Accepted: 10/16/2020] [Indexed: 01/08/2023]
Abstract
Starting from historic reflections, the current SARS-CoV-2 induced COVID-19 pandemic is examined from various perspectives, in terms of what it implies for the implementation of non-pharmaceutical interventions, the modeling and monitoring of the epidemic, the development of early-warning systems, the study of mortality, prevalence estimation, diagnostic and serological testing, vaccine development, and ultimately clinical trials. Emphasis is placed on how the pandemic had led to unprecedented speed in methodological and clinical development, the pitfalls thereof, but also the opportunities that it engenders for national and international collaboration, and how it has simplified and sped up procedures. We also study the impact of the pandemic on clinical trials in other indications. We note that it has placed biostatistics, epidemiology, virology, infectiology, and vaccinology, and related fields in the spotlight in an unprecedented way, implying great opportunities, but also the need to communicate effectively, often amidst controversy.
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Affiliation(s)
- Geert Molenberghs
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, Data Science Institute, Hasselt University, Belgium; Interuniversity Institute for Biostatistics and statistical Bioinformatics, KU Leuven, Belgium
| | - Marc Buyse
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, Data Science Institute, Hasselt University, Belgium; International Drug Development Institute, Belgium; CluePoints, Belgium.
| | - Steven Abrams
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, Data Science Institute, Hasselt University, Belgium; Global Health Institute, Department of Epidemiology and Social Medicine, University of Antwerp, Belgium
| | - Niel Hens
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, Data Science Institute, Hasselt University, Belgium; Centre for Health Economics Research and Modelling of Infectious Diseases, University of Antwerp, Belgium; Vaccine & Infectious Disease Institute, University of Antwerp, Belgium
| | - Philippe Beutels
- Centre for Health Economics Research and Modelling of Infectious Diseases, University of Antwerp, Belgium; Vaccine & Infectious Disease Institute, University of Antwerp, Belgium
| | - Christel Faes
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, Data Science Institute, Hasselt University, Belgium
| | - Geert Verbeke
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, Data Science Institute, Hasselt University, Belgium; Interuniversity Institute for Biostatistics and statistical Bioinformatics, KU Leuven, Belgium
| | - Pierre Van Damme
- Centre for Health Economics Research and Modelling of Infectious Diseases, University of Antwerp, Belgium; Vaccine & Infectious Disease Institute, University of Antwerp, Belgium
| | | | - Thomas Neyens
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, Data Science Institute, Hasselt University, Belgium; Interuniversity Institute for Biostatistics and statistical Bioinformatics, KU Leuven, Belgium
| | - Sereina Herzog
- Centre for Health Economics Research and Modelling of Infectious Diseases, University of Antwerp, Belgium; Vaccine & Infectious Disease Institute, University of Antwerp, Belgium
| | - Heidi Theeten
- Centre for Health Economics Research and Modelling of Infectious Diseases, University of Antwerp, Belgium; Vaccine & Infectious Disease Institute, University of Antwerp, Belgium
| | - Koen Pepermans
- Centre for Health Economics Research and Modelling of Infectious Diseases, University of Antwerp, Belgium; Vaccine & Infectious Disease Institute, University of Antwerp, Belgium
| | - Ariel Alonso Abad
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, KU Leuven, Belgium
| | | | | | - Catherine Legrand
- Institute of Statistics, Biostatistics and Actuarial Sciences, UC Louvain, Belgium
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Lai CC, Wang JH, Hsueh PR. Population-based seroprevalence surveys of anti-SARS-CoV-2 antibody: An up-to-date review. Int J Infect Dis 2020; 101:314-322. [PMID: 33045429 PMCID: PMC7546669 DOI: 10.1016/j.ijid.2020.10.011] [Citation(s) in RCA: 141] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 09/23/2020] [Accepted: 10/04/2020] [Indexed: 01/12/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), has led to a global pandemic. However, the majority of currently available data are restricted to laboratory-confirmed cases for symptomatic patients, and the SARS-CoV-2 infection can manifest as an asymptomatic or mild disease. Therefore, the true extent of the burden of COVID-19 may be underestimated. Improved serological detection of specific antibodies against SARS-CoV-2 could help estimate the true numbers of infections. This article comprehensively reviews the associated literature and provides updated information regarding the seroprevalence of the anti-SARS-CoV-2 antibody. The seroprevalence can vary across different sites and the seroprevalence can increase with time during longitudinal follow-up. Although healthcare workers (HCWs), especially those caring for COVID-19 patients, are considered as a high-risk group, the seroprevalence in HCWs wearing adequate personal protective equipment is thought to be no higher than that in other groups. With regard to sex, no statistically significant difference has been found between male and female subjects. Some, but not all, studies have shown that children have a lower risk than other age groups. Finally, seroprevalence can vary according to different populations, such as pregnant women and hemodialysis patients; however, limited studies have examined these associations. Furthermore, the continued surveillance of seroprevalence is warranted to estimate and monitor the growing burden of COVID-19.
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Affiliation(s)
- Chih-Cheng Lai
- Department of Internal Medicine, Kaohsiung Veterans General Hospital, Tainan Branch, Tainan, Taiwan
| | - Jui-Hsiang Wang
- Department of Internal Medicine, Kaohsiung Veterans General Hospital, Tainan Branch, Tainan, Taiwan
| | - Po-Ren Hsueh
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
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76
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Clinical performance evaluation of a SARS-CoV-2 Rapid Antibody Test for determining past exposure to SARS-CoV-2. Int J Infect Dis 2020; 103:636-641. [PMID: 33227517 PMCID: PMC7677675 DOI: 10.1016/j.ijid.2020.11.164] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/12/2020] [Accepted: 11/15/2020] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES Due to the number of asymptomatic infections and limited access to high-performance antibody tests, the true prevalence and seropositivity of SARS-CoV-2 infection remains unknown. To fill this gap, the clinical performance of a point-of-care SARS-CoV-2 Rapid Antibody Assay, a chromatographic immunoassay for detecting IgM/IgG antibodies, in near patient settings was assessed. METHODS Forty-two anti-SARS-Cov-2 positive (CoV+) and 92 anti-SARS-Cov-2 negative (CoV-) leftover samples from before December 2019 were assessed; the Elecsys® Anti-SARS-CoV-2 was used as the reference assay. Analytical specificity was tested using leftover samples collected before December 2019 from patients with common cold symptoms. RESULTS The SARS-CoV-2 Rapid Antibody Test was 100.0% (95% CI 91.59-100.0) sensitive and 96.74% (95% CI 90.77-99.32) specific, with 0.00% assay failure rate. No cross-reactivity was observed against the common cold panel. Method comparison was additionally conducted by two external laboratories, using 100 CoV+ and 275 CoV- samples, also comparing whole blood versus plasma matrix. The comparison demonstrated 96.00% positive and 96.36% negative percent agreement for plasma with the Elecsys Anti-SARS-CoV-2 and 99.20% percent overall agreement between whole blood and EDTA plasma. CONCLUSION The SARS-CoV-2 Rapid Antibody Test demonstrated similar performance to the manufacturer's data and a centralised automated immunoassay, with no cross-reactivity with common cold panels.
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Plebani M. SARS-CoV-2 antibody-based SURVEILLANCE: New light in the SHADOW. EBioMedicine 2020; 61:103087. [PMID: 33160218 PMCID: PMC7642735 DOI: 10.1016/j.ebiom.2020.103087] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 10/06/2020] [Indexed: 01/19/2023] Open
Affiliation(s)
- Mario Plebani
- Department of Laboratory Medicine, University-Hospital of Padova, Italy.
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78
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Santos EJF, Ferreira RJO, Batista R, Pinheiro V, Marques AA, Antunes I, Marques A. Health Care Workers not in the frontline are more frequently carriers of Coronavirus Disease 2019: The Experience of a Tertiary Portuguese Hospital. Infect Prev Pract 2020; 2:100099. [PMID: 34316569 PMCID: PMC7603952 DOI: 10.1016/j.infpip.2020.100099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/26/2020] [Indexed: 01/22/2023] Open
Abstract
Background Health care workers (HCWs) have a high risk of infection with coronavirus disease 2019 (COVID-19), especially those treating patients with confirmed or suspected diagnosis (front-line). Aim To evaluate the incidence and prevalence of the COVID-19 infection among HCWs and to analyse the risk factors and the clinical characteristics among infected ones. Methods Observational, retrospective, single-center study (Centro Hospitalar e Universitário de Coimbra, Portugal). Data were collected from March 1 to June 30, 2020. Findings Overall, 211 (2.63%) out of 8037 HCWs were diagnosed with COVID-19. Most of the infections occurred during the early stage of disease outbreak. Among the infected HCWs, only 20.9% (n=44) were from the front-line. Both front-line and non-front-line HCWs were exposed primarily to patients (48.6% in both groups), but the non-front-line were (presumably) more infected by colleagues (10.8% vs 24.8%, P=0.04). Front-line HCWs performed more family isolation than non-front-line (88.9% vs 82.5%, P>0.05) and presumably less family members were infected in the former group (19.4% vs 26.3%, P>0.05). The proportion of HCWs with asymptomatic infection was statistically significantly lower in the front-line group (2.4% vs 19.9%, P=0.05). Conclusion The prevention and control actions implemented were effective in mitigating the COVID-19 outbreak; HCW infections occurred mainly in the early stages. Non-front -line HCWs were at a higher risk, warranting specific attention and interventions targeting this group.
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Affiliation(s)
- Eduardo J F Santos
- Nursing Research Centre, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Portugal
| | - Ricardo J O Ferreira
- Nursing Research Centre, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Portugal
| | - Ricardo Batista
- Occupational Health Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Vítor Pinheiro
- Occupational Health Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Andréa A Marques
- Nursing Research Centre, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Portugal
| | - Isabel Antunes
- Occupational Health Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - António Marques
- Nursing Research Centre, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Portugal
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79
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Jacobs J, Kühne V, Lunguya O, Affolabi D, Hardy L, Vandenberg O. Implementing COVID-19 (SARS-CoV-2) Rapid Diagnostic Tests in Sub-Saharan Africa: A Review. Front Med (Lausanne) 2020; 7:557797. [PMID: 33195307 PMCID: PMC7662157 DOI: 10.3389/fmed.2020.557797] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/15/2020] [Indexed: 01/23/2023] Open
Abstract
Introduction: For the COVID-19 (SARS-CoV-2) response, COVID-19 antigen (Ag), and antibody (Ab) rapid diagnostic tests (RDTs) are expected to complement central molecular testing particularly in low-resource settings. The present review assesses requirements for implementation of COVID-19 RDTs in sub-Saharan Africa. Methods: Review of PubMed-published articles assessing COVID-19 RDTs complemented with Instructions for Use (IFU) of products. Results: In total 47 articles on two COVID-19 Ag RDTs and 54 COVID-19 Ab RDTs and IFUs of 20 COVID-19 Ab RDTs were retrieved. Only five COVID-19 Ab RDTs (9.3%) were assessed with capillary blood sampling at the point-of-care; none of the studies were conducted in sub-Saharan Africa. Sampling: Challenges for COVID-19 Ag RDTs include nasopharyngeal sampling (technique, biosafety) and sample stability; for COVID-19 Ab RDTs equivalence of whole blood vs. plasma/serum needs further validation (assessed for only eight (14.8%) products). Sensitivity-Specificity: sensitivity of COVID-19 Ag and Ab RDTs depend on viral load (antigen) and timeframe (antibody), respectively; COVID-19 Ab tests have lower sensitivity compared to laboratory test platforms and the kinetics of IgM and IgG are very similar. Reported specificity was high but has not yet been assessed against tropical pathogens. Kit configuration: For COVID-19 Ag RDTs, flocked swabs should be added to the kit; for COVID-19 Ab RDTs, finger prick sampling materials, transfer devices, and controls should be added (currently only supplied in 15, 5, and 1/20 products). Usability and Robustness: some COVID-19 Ab RDTs showed high proportions of faint lines (>40%) or invalid results (>20%). Shortcomings were reported for buffer vials (spills, air bubbles) and their instructions for use. Stability: storage temperature was ≤ 30°C for all but one RDT, in-use and result stability were maximal at 1 h and 30 min, respectively. Integration in the healthcare setting requires a target product profile, landscape overview of technologies, certified manufacturing capacity, a sustainable market, and a stringent but timely regulation. In-country deployment depends on integration in the national laboratory network. Discussion/Conclusion: Despite these limitations, successful implementation models in triage, contact tracing, and surveillance have been proposed, in particular for COVID-19 Ab RDTs. Valuable experience is available from implementation of other disease-specific RDTs in sub-Saharan Africa.
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Affiliation(s)
- Jan Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Vera Kühne
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Octavie Lunguya
- Department of Clinical Microbiology, National Institute of Biomedical Research, Kinshasa, Democratic Republic of Congo
- Microbiology Unit, Department of Clinical Biology, University Hospital of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Dissou Affolabi
- Clinical Microbiology, Centre National Hospitalier et Universitaire Hubert Koutoukou MAGA, Cotonou, Benin
| | - Liselotte Hardy
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Olivier Vandenberg
- Center for Environmental Health and Occupational Health, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Innovation and Business Development Unit, Laboratoire Hospitalier Universitaire de Bruxelles - Universitair Laboratorium Brussel (LHUB-ULB), ULB, Brussels, Belgium
- Division of Infection and Immunity, Faculty of Medical Sciences, University College London, London, United Kingdom
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80
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Serological assays for delayed SARS-CoV-2 case identification - Author's reply. THE LANCET RESPIRATORY MEDICINE 2020; 8:e74. [PMID: 32941851 PMCID: PMC7489942 DOI: 10.1016/s2213-2600(20)30406-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 08/28/2020] [Indexed: 11/20/2022]
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81
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Choy KW. Serological assays for delayed SARS-CoV-2 case identification. THE LANCET RESPIRATORY MEDICINE 2020; 8:e73. [PMID: 32941850 PMCID: PMC7489883 DOI: 10.1016/s2213-2600(20)30409-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 08/27/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Kay Weng Choy
- Department of Pathology, The Northern Hospital, Epping, VIC 3076, Australia.
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82
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Marlet J, Petillon C, Ragot E, Abou El Fattah Y, Guillon A, Marchand Adam S, Lemaignen A, Bernard L, Desoubeaux G, Blasco H, Barin F, Stefic K, Gaudy-Graffin C. Clinical performance of four immunoassays for antibodies to SARS-CoV-2, including a prospective analysis for the diagnosis of COVID-19 in a real-life routine care setting. J Clin Virol 2020; 132:104633. [PMID: 32927357 PMCID: PMC7831733 DOI: 10.1016/j.jcv.2020.104633] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 09/04/2020] [Indexed: 01/13/2023]
Abstract
The sensitivity of evaluated SARS-CoV-2 immunoassays ranged from 95.6% to 97.8%. The specificity was 92.1% for Euroimmun IgG and ≥ 98.9% for Abbott IgG, Wantai Ab and DiaPro confirmation IgG assays. A lack of specificity was observed for low positive Euroimmun IgG results (ratio<5) and inconclusive RT-PCR results. A lack of sensitivity was observed for early serology (<14 days) or late RT-PCR testing (>30 days).
Objectives The aim of the present study was to evaluate the clinical performance of four SARS-CoV-2 immunoassays and their contribution in routine care for the diagnosis of COVID-19, in order to benefit of robust data before their extensive use. Methods The clinical performance of Euroimmun ELISA SARS-CoV-2 IgG, Abbott SARS-CoV-2 IgG, Wantai SARS-CoV-2 Ab ELISA, and DiaPro COVID-19 IgG confirmation were evaluated in the context of both a retrospective and a prospective analysis of COVID-19 patients. The retrospective analysis included plasma samples from 63 COVID-19 patients and 89 control (pre-pandemic) patients. The prospective study included 203 patients who tested either negative (n = 181) or positive (n = 22) by RT-PCR before serology sampling. Results The specificity was 92.1 %, 98.9 %, 100 % and 98.9 % and the sensitivity 14 days after onset of symptoms was 95.6 %, 95.6 %, 97.8 % and 95.6 % for Euroimmun IgG, Abbott IgG, Wantai Ab, and DiaPro IgG confirmation SARS-CoV-2 immunoassays, respectively. The low specificity of Euroimmun IgG (for ratio <5) was not confirmed in routine care setting (98.5 % negative agreement). Serology was complementary to RT-PCR in routine care and lead to identification of false positive (Ct>38, <2 targets detected) and false negative RT-PCR results (>1 month post onset of symptoms). Conclusions Serology was complementary to RT-PCR for the diagnosis of COVID-19 at least 14 days after onset of symptoms. First line serology testing can be performed with Wantai Ab or Abbott IgG assays, while DiaPro IgG confirmation assay can be used as an efficient confirmation assay.
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Affiliation(s)
- Julien Marlet
- Service de Bactériologie-Virologie-Hygiène, CHRU de Tours, France; INSERM U1259, Université de Tours, France.
| | - Camille Petillon
- Service de Bactériologie-Virologie-Hygiène, CHRU de Tours, France
| | - Emma Ragot
- Service de Bactériologie-Virologie-Hygiène, CHRU de Tours, France
| | | | - Antoine Guillon
- Service de Réanimation Polyvalente, CHRU de Tours, France; Inserm, U1100, Centre d'Etude des Pathologies Respiratoires, Université de Tours, Tours, France
| | - Sylvain Marchand Adam
- Service de Pneumologie et Explorations Fonctionnelles Respiratoires, CHRU de Tours, France
| | - Adrien Lemaignen
- Service de Médecine Interne et Maladies Infectieuses, CHRU de Tours, France
| | - Louis Bernard
- Service de Médecine Interne et Maladies Infectieuses, CHRU de Tours, France
| | - Guillaume Desoubeaux
- Service de Parasitologie et Mycologie - Médecine tropicale, CHRU de Tours, France
| | - Hélène Blasco
- Service de Biochimie et Biologie Moléculaire, CHRU de Tours, France
| | - Francis Barin
- Service de Bactériologie-Virologie-Hygiène, CHRU de Tours, France; INSERM U1259, Université de Tours, France
| | - Karl Stefic
- Service de Bactériologie-Virologie-Hygiène, CHRU de Tours, France; INSERM U1259, Université de Tours, France
| | - Catherine Gaudy-Graffin
- Service de Bactériologie-Virologie-Hygiène, CHRU de Tours, France; INSERM U1259, Université de Tours, France
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83
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Pallett SJC, Jones R, Pallett MA, Rayment M, Mughal N, Davies GW, Moore LSP. Characterising differential antibody response is integral to future SARS-CoV-2 serostudies. J Infect 2020; 81:e28-e30. [PMID: 32739486 PMCID: PMC7392850 DOI: 10.1016/j.jinf.2020.07.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 07/26/2020] [Accepted: 07/27/2020] [Indexed: 01/09/2023]
Affiliation(s)
| | - Rachael Jones
- Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | | | - Michael Rayment
- Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - Nabeela Mughal
- Royal Centre for Defence Medicine, Birmingham, United Kingdom
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84
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Peeling RW, Olliaro PL. The time to do serosurveys for COVID-19 is now. THE LANCET RESPIRATORY MEDICINE 2020; 8:836-838. [PMID: 32717209 PMCID: PMC7380934 DOI: 10.1016/s2213-2600(20)30313-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Rosanna W Peeling
- Diagnostics Research, International Diagnostics Centre, London School of Hygiene & Tropical Medicine, London, UK.
| | - Piero L Olliaro
- ISARIC Global Support Centre, International Severe Acute Respiratory and emerging Infection Consortium, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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